There are three ways, cognition, emotion, dissociation, or trauma.

Recently, for completeness sake, because this is an academic setting, I need to review all the literature. That’s one of the requirements in my job description.

So I refer to the work of Rubin, Berntsen, Bohni, etc. And they are trying to contest the construct of flashbacks. They say there is no such thing as flashbacks. They are no different in principle from autobiographical memories.

I leave it to you to read their work. I am not impressed.

So in 2002, Hellawell and Brewin conducted a massive study of PTSD, dissociation, and flashbacks. And in this study, they included a definition of flashbacks, which I think is the best definition ever written. It was 2002, almost 20 years ago. It was one of the pioneering studies of flashbacks and so on. And this is the definition they used.

A type of memory that you experience as markedly different from those memories of the event that you can retrieve at will. The difference might be a marked sense of a reliving of the traumatic experiences.

Some report complete reliving, whereas other people report more momentary or partial reliving or perhaps just one aspect of the original experience.

For some people, flashback memories take them by surprise or swamp their mind. Finally, some people report a sense of time distortion and, for example, react to the flashback memory as though it was an event that was happening in the present. That captures and encapsulates everything we still know about flashbacks.

There’s no new knowledge since then. So this was a study in 2002.

And they observed the patients. They asked the patients to classify their traumatic memories. They asked them to classify the traumatic memories as just memories, sometimes intrusive memories, and flashbacks.

So when the patients, when the people who were subjected to the study, with the study participants, were describing flashbacks, they had involuntary motor responses. They had ticks. Their hand moved. Their faces convulsed. They lost control over the bodies. When they were just describing flashbacks in hindsight, working backwards, memories of flashbacks.

And they were not able to perform visual spatial tasks. So their cognition was severely impaired.

Other patients who were describing very difficult traumatic memories, anything from rape to worse, but had no flashbacks, had no problem to perform the visual spatial tasks. And their body did not react at all.

So flashbacks are in the nexus between body and mind. As many trauma scholars keep saying, the body remembers.

Flashbacks are like body memories. And that’s why I think emotional flashback is very misleading.

The whole body must be involved. Their body and the mind collaborate or collude to induce a flashback.

We can say the same thing about emotions and the same thing about cognitions. These are systems that are body-mind systems.

And body-mind systems invariably involve identity elements. They are identity congruent. They involve identity elements, foremost of which is memory.

But it’s not limited only to memory.

Subject for another, another perhaps, lecture.

Flashbacks are almost never, if ever, described as positive. They’re always negative. And they’re always arousing. They create hyperarousal.

I refer you to word by Huntley, Whalley, and others.

Scholars like Chou, La Marca, Stepto, they documented increases in heart rate. And flashbacks, when they’re described, they contain sensory words, words that pertain to the senses, sensa.

Much less to emotions, by the way.

When people are asked to describe flashbacks, they rarely use emotional words. They use body words, mentions of death, fear, helplessness, and horror, but body-based, like they’re about to die, or something very bad is going to happen to them.

I refer you to word by Hellowon in 2004.

And Brewin says like the real life situations PTSD patients encounter, the same words and phrases tend to elicit flashbacks repeatedly, but not invariably.

Flashback elicitation is probabilistic, rather than a predictable process.

So what’s the difference between flashbacks and normal memory, or normal episodic memory?

It’s because in flashbacks, conscious attention is directed, channeled, like a laser beam, onto objects and scenes, such that by virtue of sharing the same location in space, individual features are bound together to create a stable, contextualized representation that can be retrieved or inhibited at will.

That is normal episodic memory.

So memory is an act of will. In typical memory, we first want to remember, then what we do, we collect all kinds of data items, location, smells, sights, we put them together, we bind them together, and we embed them in a context, and then we retrieve this totally confabulated and invented story, narrative, that usually is counterfactual.

90% of memories are wrong after 10 years, 50% are wrong after one year.

So there are studies by Treisman and Gelade as early as 1980 that demonstrate this.

But when there is a traumatic event, there’s a problem with attention.

I refer you to my video where I describe the affinity between attention deficit hyperactivity disorder, trauma dissociation, and personality disorder.

Attention is critical. When we form memories, our attention is usually focused. Our attention shuts out, eliminates 95% of the information. We absorb at any given time less than 5% of the information that reality offers us on a silver plate.

We have very selective attention leads to selective memory. And based on this process of selectivity, we generate memories that sit well with, that conform to a narrative, a storyline, the script of our lives.

We struggle very hard to maintain a coherent and cohesive story of who we are, what we are, where we are going, and when we’re going to get there, and who other people are in our lives. Maintaining the internal consistency and external consistency of the story of our lives, these stories, that’s the main mental and psychological occupation that we have.

And so trauma disrupts this process.

I’ll quote from Brewin.

During traumatic events, however, attention tends to be restricted and focused on the main source of danger so that sensory elements from the wider scene encoded by the perceptual memory system will be less effectively bound together, producing fragmented and poorly contextualized memories that are difficult to control.

Laboratory research has shown that such unattended patterns or events providing they’re sufficiently novel produce long-term memory traces. The existence of these traces can be detected, for example, through facilitation or negative priming effects or representation of the stimuli, even though a memory of the original pattern cannot be deliberately retrieved.

I refer you to studies by Treisman, aforementioned Treisman, and Shepard starting in 1996.

So there is an involuntary element in flashbacks, and flashbacks depend on involvement of an involuntary perceptual memory system that is distinct from ordinary episodic memory. And Brewin called it in 2010, 2014, he called it the revised dual representation model.

It’s like we have a two-track system, voluntary and involuntary.

The voluntary system is what we call ordinary episodic memory. And the involuntary perceptual memory system is, copes, deals with trauma.

I would reverse the order. I would say the trauma uses the second memory system to relate to the world.

This is the track of the trauma. This is the pathway, the trajectory of trauma.

So cognition and emotion, they use episodic memory formation, while trauma uses the second perceptual track.

So I agree with Bremen that there is a dual representation, but I disagree that the dual representation is an outcome of the trauma.

I think the trauma is fundamental, is initial, as we are born with trauma. I think we are born with the capacity to be traumatized.

And we use the second system of perceptual memory.

Now, this system is much less organized. It has no narrative. It has no control. It’s out of control, literally out of control. That’s why we have flashbacks.

And it’s out of control because it’s not embedded in a context. It’s not part of a narrative.

When something is out of context, out of the blue, out in the air, I mean, it’s very bothering. It’s very disturbing. And you tend to think about it a lot more.

If someone you know well suddenly behaves in a way which shocks you, you would tend to think about this misbehavior a lot more than you would think about his other behaviors.

Pain flashbacks have been described in which it is somatic rather than visual sensations that are repeatedly re-experienced as though they were happening in the presence.

So I refer you to Salomons, Osterman, Gagliese, Katz, and others. They describe pain flashbacks.

It seems that the body itself, divorced from the mind, has its own kind of memory, bodily memory, if you wish, the body remembers. Van der Kolk. So bodily memory, and that bodies also have flashbacks. We all acquainted with the phantom organ or phantom pain.

It’s a dissociated pain. The organ is amputated. Someone’s leg is amputated. He still feels the leg. The leg still itches. There’s still pain in the missing leg.

Isn’t this dissociation? Isn’t this traveling back in time? Isn’t this, in other words, flashback?

Again, I refer you to work by Whalley, Farmer, Brewin himself in 2007.

Frightening delusions and hallucinations such as occur in psychotic disorders or intensive care patients. This is also a form of traumatic re-experiencing.

These people believe that the hallucination is real. When your life flashes in front of you, it’s not like you’re watching a movie. You feel that you’re there. People insisted that they were there.

When people have out-of-body experiences or near-death experiences, as described by Moody and others, they believed when they had returned to their bodies, so to speak, they regained consciousness.

They claim to have been there. It’s re-experiencing. It’s re-vividness. It’s relieving.

These are all forms of flashbacks.

Flashback, therefore, doesn’t have to be a real life event. You could flash back to an imaginary event, to a paracosm, to an imaginary kingdom.

For example, narcissists flash back to the period before the false self, but also flash back to elements of the false self. The process of re-experiencing, relieving, is not limited to external objects and the events that involve external objects. You could flash back internally into internal objects and into the dialogue and the interaction between internal objects.

Processes such as introjection, therefore, might involve flashbacks.

Quite a few scholars dealt with the issue of hallucinations and delusions and fantasies as forms of flashback. I refer you to Berry, Ford, Jellicoe-Jones, Haddock, Gracie, Hardy, Fornells-Ambrojo, Wade. They all described hallucinations, delusions, fantasies, and so on as forms of flashback or as processes that at some stage involve flashback.

You can flash back internally, not only externally.

Hallucinations, just to be totally rigorous, this is an academic setting and I would hate to be considered a YouTube personality, so hallucinations do not meet the current DSM-5 criteria for a traumatic event, and the fact that someone had a terrifying experience and developed characteristic symptoms could be enough for PTSD, but not for flashbacks, not for that element, diagnostic element, symptom of PTSD.

So we need to be very careful. Not all hallucinations qualify as flashbacks, but if the hallucination is intrusive, if it has negative emotionality, negative contents such as horror, fear, terror, if it involves vivid, re-vividness, vivid re-experiencing, vivid re-living, and if it induces trauma, I think it can safely qualify.

I think Brewin others think it can safely qualify as a flashback.

Finally, I refer you to additional articles about treatments focused on flashbacks, going from flashbacks to trauma rather than from trauma to flashback.

So article Brief, Mindfulness-Based Intervention for Rapid Release of Ptsd Symptoms and Specific Phobia. It was written by Smith, California Institute of Integral Studies. It’s actually a PhD dissertation. It’s published this year, 2020, and this is a very good article in military psychology.

Can you believe it? Military psychology, good article.

Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention, again written by Janine and by Smith and Hartelius. It was published in February this year, February2020, in military psychology.

Okay, let’s pull all the strands.

Flashbacks are now a symptom of post-traumatic stress disorder. There are various types of post-traumatic stress disorder depending which classification or taxonomy you wish to adopt.

Flashbacks are connected intimately to trauma and to dissociation. Flashbacks involve relieving the experiences. Flashbacks are authentic, faithful to the original, and in this sense they resemble very much a hypnotic dissociated state.

Hallucinations, psychotic elements, psychotic symptoms, delusions, and some types of fantasies could be construed as dissociated flashbacks. And in this sense, certain types of mental health disorders, many more mental health disorders should involve flashbacks or we should reconceive of flashbacks as elements and symptoms of many more mental health disorders.

The main function of flashbacks seems to be processing of trauma and separating, defending against the memories of trauma by disengaging from the world.

So it’s really a dissociative reservoir, dissociative amnesiac mechanism.

So the flashback allows the person to disengage and retreat and withdraw to a familiar situation that he had already survived and he knows he has survived. However difficult flashbacks are, they’re safe and very often they’re safer than reality or inability to cope with reality.

So flashbacks are a safety valve against being overwhelmed by emotions, overwhelmed by cognitions, overwhelmed by memories, dysregulation, extreme dysregulation leading to the decompensation, disintegration and acting out.

And so we should expect to find flashbacks in borderline personality disorder, narcissistic personality disorder, all the dissociative identity disorders. And we should find flashbacks in all trauma related conditionsincluding CPTSD and PTSD.

Indeed, that’s the very reason we are seriously contemplating to merge all these because there’s no clear difference between borderline personality disorder and CPTSD. They all involve dissociative mechanisms.

The situation is such that I’m proposing to consider that the human mind, the human brain has three ways of relating to the world, not two, cognitions, emotions and dissociation. Dissociation is a way of coping with the fact that the world constantly traumatizes us. And it is a fact established in numerous studies that even very, very, very young children employing and use dissociation are traumatized and have flashbacks.

So this must be something very, very fundamental, not acquired. We are born with it, as we are born with cognitions, as we are born with emotions.

And so I think there are three languages, three interactive modes, three pathways of relating to the world, to others, objects, and to internal objects. And these pathways are cognitions, emotions, and dissociative processes, including traumatic dissociative processes.

And when we fail to distinguish internal objects from external objects with the management of our internal environment, including all the internal objects and constructs, fails, or when we confuse and conflate external and internal objects, one of the main symptoms is dissociation, dissociative disorders, including flashbacks.

So flashbacks are a symptom, they’re an indicator that there is a massive systemic failure of distinguishing between internal and external in projection and projection. All these processes are compromised. There’s a problem.

In extremes, this problem results in psychotic disorders.

In the middle ground, this failure to integrate external and internal and separate them with clear cognitive, emotional, and other boundaries. In the middle ground, this creates borderline personality disorder, or borderline narcissistic disorders, as Kernberg had it.

Kernberg claimed the borderline and narcissism and psychosis, they’re all first cousins. So this is in the middle.

And in the benign or healthy end of the spectrum, we all experience trauma repeatedly. We all have mini fleeting flashbacks, mini fleeting traumas. And we use dissociation on a regular basis to cope with the world, as we use emotions, as we use cognitions.

Okay, a lot to chew on, and a lot to think about.

Despite what I’ve said about Pete Walker, I encourage you to try and read his book. It’s not a rigorous clinical experience. It wouldn’t pass peer review. But he has many, many interesting insights based on experience with clients and others, many interesting insights into the presentation phase of CPTSD. How CPTSD presents in therapy or in clinical settings.

So he’s very descriptive. He’s not very good in analyzing, he’s not very knowledgeable, but his descriptions are worth absolutely getting acquainted with.

Otherwise, please stick to serious scholars, the ones I’ve enumerated in this presentation.

Assignments, I remind you, please, assignments through the common platform, the SIAS-CIAPS outreach common platform. And to both academic establishments, Southern Federal University and CIAPS, I wish a good and healthy day. Stay safe. We want you all back face to face when this is over. Don’t let the virus traumatize you. And don’t ever flash back to this period. It’s not a pleasant one. Thank you.